Provider Demographics
NPI:1487683702
Name:MEHTA, CHETAN KUMAR (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:CHETAN
Middle Name:KUMAR
Last Name:MEHTA
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 VILLAGER
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2459
Mailing Address - Country:US
Mailing Address - Phone:714-389-1919
Mailing Address - Fax:
Practice Address - Street 1:13372 NEWPORT AVE
Practice Address - Street 2:SUITE C
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3426
Practice Address - Country:US
Practice Address - Phone:714-838-1238
Practice Address - Fax:714-838-9586
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD495971223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics